Prevention & Recovery

E-cigarettes: Everything you need to know

Do you vape? Even if you don't, chances are you know someone who does. The popularity of electronic cigarettes—battery-powered devices that turn liquid nicotine into smoke-free vapour that users inhale—has exploded. In the U.S., e-cigarettes are now an estimated $1.5-billion market that has been projected to grow nearly 25 percent every year until 2018, according to Research and Markets, a firm that gauges global trends.

North of the border, the situation is murkier. Though e-cigarettes haven't been approved for sale by Health Canada, it's fairly easy for consumers to find e-liquid cartridges, both nicotine and nicotine-free, online or at a corner store. "This isn't a novelty product anymore," says David Hammond, associate professor in the School of Public Health and Health Systems at the University of Waterloo. "No other product has become this popular, this prevalent this quickly in a very long time."

With all that puffing comes a cloud of controversy. First designed to help smokers kick their habit, e-cigarettes have lost some of their "health" halo. Levels of nicotine and other ingredients vary by brand, making blanket assessments difficult, and researchers aren't certain that people who give up smokes for e-cigs will quit for good.

Teens who have never tried tobacco cigarettes are also picking up vaping. A recent survey revealed that 8.5 percent of Grade 6 students and 22 percent of first-year high school students in Quebec have tried e-cigarettes. The study, conducted by the Quebec division of the Canadian Cancer Society, also found that 18 percent of high school students who have never smoked cigarettes have tried e-cigarettes.

Last fall, federal Health Minister Rona Ambrose asked Parliament's Standing Committee on Health to study the risks and benefits of e-cigarettes, possibly signalling change is afoot. Vancouver and Red Deer, Alta., have banned the use of e-cigarettes in public places and the sale of the devices to minors. Meanwhile, the Ontario government has introduced a bill extending tobacco-cigarette laws to e-cigarettes, prohibiting use by and distribution to anyone aged 18 or younger.

As cities restrict sales and prohibit vaping in public spaces, questions continue to swirl around the issue of e-cigarettes.

Are e-cigarettes a lifesaver? For some former smokers, the answer is a resounding yes. They say that using nicotine-containing e-cigarettes, which mimics the feel of smoking tobacco, is what helped them finally kick the habit. A recent Forum Research survey found that 24 percent of Canadian adults who had given up smoking did so by turning to e-cigarettes. Mounting evidence is backing up these anecdotal claims.

The Cochrane Collaboration, a pres­tigious not-for-profit network of medical experts, published its review of two double-blind e-cigarette studies this past December. The findings suggest that nicotine-containing e-cigarettes help smokers quit or cut back on tobacco use.

However, more research is required. Few large-scale studies have been conducted, and though research looks promising, there are many unanswered questions about whether e-cigarettes are a viable smoking-cessation aid in the long term, says Dr. Peter Selby, clinical scientist and chief of the addictions program at the Centre for Addiction and Mental Health (CAMH) in Toronto. "The honest answer is we don't know for sure."

Will e-cigarettes lure kids into trying the real thing? The short answer is no—for now. A 2014 report from the U.S. National Institutes of Health reveals that youth smoking rates have decreased over the past five years. But the high number of teens trying e-cigarettes is stoking fears that this trend could reverse. "It would be a tragedy if this product undid some of the great progress made to date in reducing cigarette smoking by teens," says Lloyd Johnston, principal investigator in the study and senior research scientist at the University of Michigan's Institute for Social Research.

Before we declare a state of emergency, some encouraging signs suggest that the vaping-to-smoking argument may not hold water. A study published last spring in the Canadian Journal of Public Health indicates that the vast majority of young people who have tried e-cigarettes are regular smokers: 16 percent reported vaping, and only five percent of those who had vaped were nonsmokers. That's in line with what Hammond has seen. Few nonsmokers try vaping more than once or twice, he says.

A big caveat: As the e-cigarette evolves, its nicotine-delivery system may become more efficient and could lead casual users to get hooked on nicotine—and that could open the door to regular cigarette use. Dr. Selby points out an interesting alter­native for the future of both products: "If e-cigarettes become viable alternatives [to traditional cigarettes], combustible cigarettes will need to be banned outright because a potentially safer option would be available to those who wish to obtain nicotine recreationally." What about vaping and drugs? Reports that some people are vaping liquid marijuana have some parents concerned. A recent study published in The New England Journal of Medicine found that, when exposed to high levels of nicotine, mice were much more likely to become addicted to cocaine due to the activation of a rewards-related gene.

But Dr. Selby is cautious. "It's a stretch to say there is the possibility that e-cigarettes could lead to hard-drug use," he says. "The gateway theory of hard-drug addiction is highly contested. Current understanding of addiction includes genetic predisposition, preexisting or developing mental health problems, social determinants and personality structures all interacting to determine if someone is going to get addicted or progress to hard drugs."

Nevertheless, groups such as the World Health Organization and the Heart and Stroke Foundation are calling for governments to restrict e-cigarette advertising aimed at youth and nonsmokers, and to ban the sale of e-cigarettes to minors. That way, adults who want to vape instead of smoke can have access to products that are safe and regulated, and the risk to youth is minimized.